Treatment of morbid obesity by intraparietogastric administration of botulinum toxin: a randomized, double-blind, controlled study.
ABSTRACT The stomach is the main target organ for bariatric surgery, but no medical treatment has been developed to increase satiety and decrease food intake via gastric pathways. The aim of our study was to investigate whether or not the intraparietogastric administration of botulinum toxin A (BTX), able to modify the motility patterns of the stomach, could be useful for treatment of obesity.
Double blind controlled study.
Twenty-four morbidly obese patients (mean weight (s.e.m.) 116.1+/-4.89 kg, mean body mass index (BMI) 43.6+/-1.09 kg/m(2)) were blindly randomized to receive 200 IU BTX or placebo into the antrum and fundus of the stomach by intraparietal endoscopic administration.
We evaluated weight loss, BMI changes, satiety score, the maximal gastric capacity for liquids and the gastric emptying time (octanoic acid breath test).
The two groups were homogeneous for anthropometric characteristics. Eight weeks after treatment, BTX patients had significantly higher weight loss (11+/-1.09 vs 5.7+/-1.1 kg, P<0.001) and BMI reduction (4+/-0.36 vs 2+/-0.58 kg/m(2), P<0.001) and a higher satiety score on a visual analogic scale (7.63+/-0.38 vs 4.72+/-0.44, P<0.001) than controls. Furthermore, BTX patients showed a significantly greater reduction in maximal gastric capacity for liquids (266.6+/-48 vs 139+/-31, P<0.001) and a greater prolongation in gastric emptying time (+18.93+/-8 vs -2.2+/-6.9 min, P<0.05). No significant side effects or neurophysiologic changes were found.
Topical intragastric BTX was effective in reducing food intake and body weight in morbidly obese patients.
- SourceAvailable from: Furio Brighenti[show abstract] [hide abstract]
ABSTRACT: The relative roles of gastric relaxation and the neuroendocrine signals released by the small intestine in the perception of nutrient induced sensations are controversial. The different effects of long chain (LCT) and medium chain (MCT) triglyceride ingestion on perception, gastric relaxation, and hormonal release may help to elucidate the mechanisms underlying nutrient induced sensations. To compare the effects of intraduodenal LCT and MCT infusions on perception, gastric tone, and plasma gut hormone levels in healthy subjects. Nine fasting healthy volunteers. The subjects received duodenal infusions of saline followed by LCTs and MCTs in a randomised order on two different days. The sensations were rated on a visual analogue scale. Gastric tone was measured using a barostat, and plasma gut hormone levels by radioimmunoassay. LCT infusion increased satiation scores, reduced gastric tone, and increased the levels of plasma cholecystokinin, gastric inhibitory polypeptide, neurotensin, and pancreatic polypeptide. MCT infusion reduced gastric tone but did not significantly affect perception or plasma gut hormone levels. LCTs produced greater gastric relaxation than MCTs. The satiation induced by intraduodenal LCT infusion seems to involve changes in gastric tone and plasma gut hormone levels. The gastric relaxation induced by MCT infusion, together with the absence of any significant change in satiation scores and plasma hormone levels, suggests that, at least up to a certain level, gastric relaxation is not sufficient to induce satiation and that nutrient induced gastric relaxation may occur through cholecystokinin independent mechanisms.Gut 02/2000; 46(1):32-6. · 10.73 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: An enhanced gastric emptying rate might reduce the satiating effect of food and thereby promote obesity. Gastric emptying rate has previously been compared between obese and lean subjects with conflicting outcome. Comparison of gastric emptying rate in lean and obese subjects before and after a major weight reduction. The study was designed as a case-control study comparing obese and lean subjects and a subsequent comparison of obese subjects before and after a dietary induced major weight reduction. Gastric emptying rate following a solid test meal was estimated scintigraphically for 3 h using the left anterior oblique projection. Nineteen non-diabetic obese (mean BMI=38.7 kg/m2) and 12 lean (mean BMI=23.1 kg/m2) males matched for age and height. All obese subjects were re-examined after a mean weight loss of 18.8 kg (95% CI, 14.4-23.2) achieved by 16 weeks of dietary intervention followed by 8 weeks of weight stability. When comparing obese and lean subjects no differences were seen in overall 3 h emptying rate (30.3% per hour vs 30.5% per hour). However, a trend towards a higher percentage gastric emptying during the initial 30 min was seen in the obese when compared to lean subjects (24.0% vs 17.8% of the test meal; P=0.08). Weight loss was associated with a reduction in percentage gastric emptying during the initial 30 min (from 24.0% to 18.3% of the test-meal; P<0. 02), whereas the overall 3 h emptying rate was unaffected (30.3% vs 30.9% per hour). Neither initial or overall emptying rate differed between reduced-obese and lean subjects. Overall 3 h gastric emptying rate was similar in obese and normal weight males, and unaffected by a major weight loss. However, percentage gastric emptying during the initial 30 min for a solid meal appeared to be increased in obese males and was normalized after a major weight reduction.International Journal of Obesity 08/2000; 24(7):899-905. · 5.22 Impact Factor
Article: A war on obesity, not the obese.[show abstract] [hide abstract]
ABSTRACT: In their efforts to lose weight, obese individuals may be fighting a powerful set of evolutionary forces honed in an environment drastically different from that of today.Science 03/2003; 299(5608):856-8. · 31.20 Impact Factor
Treatment of morbid obesity by intraparietogastric
administration of botulinum toxin: a randomized,
double-blind, controlled study
D Foschi1, F Corsi1, M Lazzaroni2, O Sangaletti2, P Riva3, G La Tartara3, M Bevilacqua4, M Osio5,
A Alciati6, G Bianchi Porro2and E Trabucchi1
1I Unit of Surgery, Department of Clinical Sciences L Sacco, San Siro Clinical Institute, University of Milan, Milan, Italy;
2Chair of Gastroenterology, Department of Clinical Sciences L Sacco, University of Milan, Milan, Italy;3Unit of Dietology,
L Sacco Hospital, Milan, Italy;4Unit of Endocrinology, L Sacco Hospital, Milan, Italy;5Unit of Neurology, L Sacco Hospital,
Milan, Italy and6Unit of Psychiatry, L Sacco Hospital, Milan, Italy
Objective: The stomach is the main target organ for bariatric surgery, but no medical treatment has been developed to increase
satiety and decrease food intake via gastric pathways. The aim of our study was to investigate whether or not the
intraparietogastric administration of botulinum toxin A (BTX), able to modify the motility patterns of the stomach, could be
useful for treatment of obesity.
Design: Double blind controlled study.
Subjects: Twenty-four morbidly obese patients (mean weight (s.e.m.) 116.174.89kg, mean body mass index (BMI)
43.671.09kg/m2) were blindly randomized to receive 200IU BTX or placebo into the antrum and fundus of the stomach by
intraparietal endoscopic administration.
Measurements: We evaluated weight loss, BMI changes, satiety score, the maximal gastric capacity for liquids and the gastric
emptying time (octanoic acid breath test).
Results: The two groups were homogeneous for anthropometric characteristics. Eight weeks after treatment, BTX patients had
significantly higher weight loss (1171.09 vs 5.771.1kg, Po0.001) and BMI reduction (470.36 vs 270.58kg/m2, Po0.001)
and a higher satiety score on a visual analogic scale (7.6370.38 vs 4.7270.44, Po0.001) than controls. Furthermore, BTX
patients showed a significantly greater reduction in maximal gastric capacity for liquids (266.6748 vs 139731, Po0.001) and a
greater prolongation in gastric emptying time (þ18.9378 vs ?2.276.9min, Po0.05). No significant side effects or
neurophysiologic changes were found.
Conclusions: Topical intragastric BTX was effective in reducing food intake and body weight in morbidly obese patients.
International Journal of Obesity (2007) 31, 707–712. doi:10.1038/sj.ijo.0803451; published online 26 September 2006
Keywords: botulinum toxin A; gastric emptying; weight loss; diet
Obesity is epidemic in the western countries. It affects more
than 30% of the general population in USA and more than
10% in Italy.1,2Genetic, social, psychological and behavioural
factors work in favour of obesity3and make it difficult both to
prevent and to treat this condition. It is a paradox that,
despite the extensive research in the pharmacological treat-
ment of obesity,4the number of drugs available for treatment
in the past 10 years has decreased as the prevalence of obesity
The target organ of pharmacological treatment is the
central nervous system, and only recently research has
focused on the gastrointestinal tract with the development
of lipase inhibitors.6On the contrary, bariatric surgery is
based on gut manipulation with restrictive or malabsorptive
operations acting through reduction of the gastric reservoir
or of nutrient transport across the intestinal barrier.7After
bariatric surgery, morbidly obese patients experience reduced
appetite and early satiety.7These effects are probably related
to endocrine or paracrine effects of the operations. Vertical
Received 25 November 2005; revised 24 June 2006; accepted 3 July 2006;
published online 26 September 2006
Correspondence: Professor D Foschi, I Unit of Surgery, Department of Clinical
Sciences L Sacco, Istituto Clinico San Siro, University of Milan, Via Monreale
18, Milan 20148, Italy.
International Journal of Obesity (2007) 31, 707–712
& 2007 Nature Publishing Group All rights reserved 0307-0565/07 $30.00
banded gastroplasty increases post-meal cholecystokinin
plasma levels,8whereas Roux-en-Y gastric by-pass inhibits
basal and post-prandial ghrelin plasma levels9and increases
increases cholecystokinin, motilin, glucagon-like peptide 1
and PYY,11delays gastric emptying and reduces hunger
sensations. As cholecystokinin, ghrelin and PYY also influ-
ence gastrointestinal motility, it can be hypothesized that
reduction of gastric emptying could contribute to the satiety
effect of the operations. All these data suggest that reducing
gastric emptying could be beneficial for body weight loss
in patients who follow a strict hypocaloric diet.
Botulinum toxin A (BTX) has long been used to induce
functional denervation of the voluntary muscles12and has
recently been used to treat many gastrointestinal disorders,
like achalasia and gastroparesis.13The effect of BTX is strictly
related to the site of administration: when the oesophageal
or the pyloric sphincter is injected, motility is increased.
We postulated that administration of BTX in the antrum
and fundus of the stomach of the obese patients could
reduce gastric emptying and make it easier to adhere to
dietary prescriptions. In this paper, we describe the results of
a double-blind, placebo-controlled study describing the
ability of BTX to increase satiety and induce weight loss in
Patients and methods
The study was performed at the L Sacco Hospital and the S
Siro Clinical Institute between January and November 2004.
All morbidly obese patients who required bariatric surgery
to reduce body weight were examined according to the
admission criteria. The protocol was approved by the Ethic
Committee of the L Sacco Hospital and conducted according
to the Declaration of Helsinki Principle. All patients gave
their informed consent to the diagnostic and therapeutic
Thirty morbidly obese patients between 18 and 65 years,
with body mass index (BMI) 435kg/m2and two complica-
tions of obesity or with BMI 440kg/m2without complica-
tions, were admitted to the study.
Selection of patients.
potentially), surgery of the stomach or gastrointestinal
diseases was considered an exclusion criterion. A recent
(o3 months) antiobesity treatment was also considered a
contraindication for participating to the study.
All patients had a preliminary interview by a dietitian to
assess their eating behaviour and to exclude heavy binge
eating. During the first week, they completed a diet diary to
evaluate the amount of introduced calories and proportion
of fat, protein and carbohydrate.
A history of neoplasia, pregnancy (also
They had also a neurological evaluation to exclude
patients with previous botulism, neurological or neuro-
All patients had a structured clinical interview conducted
face to face by a psychiatrist, using the Italian version of the
Mini International Neuropsychiatric Interview, to exclude
severe psychiatric illnesses (including psychotic disorders,
current mood and anxiety disorders, bulimia, alcohol or
substance abuse or dependence) or heavy binge-eating
disorder, as conditions reducing the ability to follow the
prescribed diet. Finally, all patients had a clinical interview
and specific blood tests to exclude any possibility of
endocrine obesity. Two patients with minor hypothyroidism
had replacement therapy before admission to the thera-
On the basis of the contraindications that emerged during
the preliminary clinical examinations, five patients were
excluded from the study. One more patient withdrew
her consent. Twenty-four patients were admitted to the
diagnostic and therapeutic procedures.
Diagnostic procedures and evaluation criteria
sured at the first visit with the patient wearing light clothing
and no shoes. BMI was also calculated as body weight
(kg)/height (m)2. Waist circumference was measured at the
minimal circumference between iliac crest and last rib edge.
Hip circumference was measured at the greatest circumfer-
ence through the major trochanters. Blood pressure and
heart rate were also assessed.
Routine blood tests were performed after a 12h overnight
fast, the day after. Serum levels of total cholesterol, high-
density lipoprotein cholesterol, triglycerides, alanine amino-
transferase, aspartate aminotransferase, gamma-glutamyl
transpeptidase, bilirubin, creatinine, alkaline phosphatase,
total protein and red blood cells, white blood cells and
platelet count were determined.
Satiety evaluation: The patients were asked to describe their
satiety to the standard dinner prescribed for the day before
the visit using a graphic rating scale that combined verbal
descriptors on 0–100mm scale: 0, hunger; 20, no satiety; 40,
mild satiety; 60, moderate satiety; 80, high satiety; and 100,
complete fullness. The dinner was equivalent in kilocalories
to that prescribed during the period of diet restriction after
treatment. The assessment was performed at home to avoid
the influence of personal attitudes about time, flavouring
and good cooking of foods, as these factors cannot be
optimized for hospital meals.
On three separate days, the patients also performed the
following tests as outpatients:
Maximal liquid gastric capacity test: As the patients had a
liquid diet after the procedure, a maximal liquid gastric
capacity test was performed. Patients were asked to drink
a liquid solution (Osmolite HR, Abbott Park, IL, USA;
(protein 30.3%, lipid 17.6%, carbohydrate 53%; osmolarity
Body weight and height were mea-
Botulinum toxin A and weight loss
D Foschi et al
International Journal of Obesity
244mosM/l), diluted 1:1 in water, 1ml¼0.5kcal, at a
constant rate (30ml/min) until they felt a complete fullness
sensation orabdominal discomfort.
expressed as kilocalories.
Gastric emptying evaluation: All tests were performed after
an overnight fast. The test meal consisted in a standard
bun (5.8% protein, 33.3% lipid and 57.5% carbohydrate,
378kcal), with 100mg of 2mCi of octanoic acid (13C) added.
The test meal was followed immediately by 250ml of water.
Breath samples were taken immediately before the test meal
and every 30min thereafter for 3h. Samples were analysed
by a mass spectrometer (Breath mass plus, Finnigan,
Germany) to measure13CO2. The results were measured as
half-emptying time (min) and lag-time (min).
Neurophysiologic evaluation: Distant effects of intragastric
BTX administration were assessed by studying neuro-
muscular transmission. Abductor Digiti Minimi compound
muscle action potential (CMAP) was recorded after stimula-
tion of the right ulnar nerve according to Desmedt and
Borenstein14Extensor digitorum (EDC) muscle fibre jitter
was measured by single fibre electromyograph according to
Ekstedt et al.15Jitter is the variability of the interpotential
interval between two or more single muscle fibres belonging
to the same motor unit. The jitter is expressed as the mean
value of consecutive differences of successive interpotential
After completion of the diagnostic procedures, patients were
randomized in a double-blind manner to receive intragastric
administration of BTX (200IU) or placebo (saline).
All therapeutic procedures were performed between 1400
and 1500 hours after a 6h fasting. Under diazepam
administration, an Olympus GIF IT 130 operative gastro-
scope was used for a preliminary evaluation of the oesopha-
gus, stomach and duodenum. Seventeen patients had sliding
hiatus hernia, in three cases associated with esophagitis,
three patients had antral gastritis and one patient had
pseudopolyps of the fundus. One patient had a gastric ulcer
and another duodenitis suggesting Crohn’s disease. These
last two patients had negative biopsies and were treated with
Proton Pump Inhibitors for 45 days before the procedure was
To inject BTX (Botox, Allergan, Irvine, CA, USA, 10IU in
0.5 saline) or saline (0.5ml), we used an Endoflex needle,
2.3mm in thickness and 230cm in length. The microinjec-
tions were performed at the four cardinal points starting
3cm from the pyloric ring, and repeated three times moving
2cm towards the angulus each time. Four more micro-
injections were performed 2cm below the cardias, and the
last four doses were injected into the fundus of the stomach.
The total dose was 200IU.
The time to accomplish the procedure was always less
than 10min. No significant acute side effects were recorded.
All patients were observed for 1h. Only one patient
complaining of abdominal pain had to be observed for 18h.
All patients had blood pressure and heart rate monitoring
for 3 days. Fatigue, nausea, vomiting and diarrhoea were
A 1200kcal liquid diet (protein 15%, lipid 33%, carbohydrate
52%) was prescribed starting immediately after the endo-
scopic procedure. The diet was based on a personal choice
between several market components for each, with a weekly
balance between the daily
instructed to follow the diet for the 8 following weeks.
meals. Thepatients were
Every week, the patients attended our outpatient department
to evaluate the satiety to the last standard dinner, the body
weight, BMI, waist and hip circumference. The neuro-
physiologic test was performed 8 days after the injection
of the tested substances. Final body weight measure-
ment, anthropometric measures, maximal liquid gastric
capacity test, octanoic acid breath test and blood tests
were performed 8 weeks after treatment. All measurements
were performed by an observer unaware of the treatment
Results were expressed as mean7s.e.m. Differences between
groups were compared using a two-tailed Student’s t-test for
unpaired data. Differences between times in the same group
were compared using a two-tailed Student’s t-test for paired
data. Gastric emptying time differences between groups were
evaluated using the rank test of Wilcoxon. Differences with
Po0.05 were considered significant.
All the patients completed the diagnostic and therapeutic
procedures. There were no withdrawals during the study.
The two treatment groups were homogeneous for age
(BTX: 40.673.5 years; placebo: 45.273.7 years), sex ratio
(BTX: M/F¼0.2; placebo: M/F¼0.3) and anthropometric
characteristics (Table 1).
Acute side effects and neurophysiologic assessment
There were no acute side effects after BTX administration.
Blood pressure was slightly decreased (?10mm Hg) after
treatment. Heart rate was unchanged. No patient experi-
enced fatigue, nausea, vomiting or diarrhoea.
Botulinum toxin A and weight loss
D Foschi et al
International Journal of Obesity
No subject in either BTX or placebo group presented
abnormal values of CMAP decrement at any stimulation rate,
CMAP incremental response during high-frequency stimula-
tion or Jitter MCD before or after treatment.
Significant reduction in body weight was evident in both
groups from the first week after the procedure (Figure 1,
Table 1). Patients treated with placebo had a significant
weekly decrease of body weight for the first month,
and patients treated with BTX for the whole study time. At
the end of the study, patients treated with BTX had a
greater reduction of body weight (1171.09 vs 5.771.1kg,
Po0.0006) and BMI (470.36 vs 270.58kg/m2, Po0.001)
than the control group. There were no significant differences
in waist and hip reduction between the two groups of
Both treatments induces a higher satiety in comparison to
the baseline values (Po0.001) (Figure 2). In BTX-treated
patients, there were no differences between the scores
obtained at any time after treatment, whereas a significant
reduction of effects was found in placebo-treated patients
from the third week (3rd week vs 1st week, Po0.01).
A significant difference between groups was evident after
2 weeks (Po0.01) and persisted throughout the study.
Gastric capacity test
The maximal gastric capacity for liquids was 545748kcal in
BTX- and 475.8728kcal in placebo-treated patients. After 8
weeks, it was reduced to 275.2728.8 and to 332.64734kcal,
respectively, with a significant difference between times both
in BTX- (Po0.004) and placebo- (Po0.002) treated patients.
The reduction in the total liquid amount was in favour of
BTX (266748 vs 139731kcal, Po0.001).
Gastric emptying test
The half-emptying time of the stomach 8 weeks after
treatment was significantly delayed in patients treated with
BTX (þ18.9378min) in comparison to patients treated
with placebo (?2.276.9min, Po0.05, rank test of Wilcoxon)
Anthropometric effects of BTX in obese patients
Waist circumference (cm)
Hip circumference (cm)
Body weight reduction (kg)
Waist circumference reduction (cm)
Hip circumference reduction (cm)
Abbreviations: BMI, body mass index; BTX, botulinum toxin A. *Po0.001 between times. **Po0.001 between groups.
Weight loss after botox administration
Weight loss Kg
BTX experienced weight loss throughout the study, with significant
differences between each time of observation. Patients treated with placebo
had a significant weight loss only in the first 4 weeks after treatment.
Reduction in body weight after treatment. Patients treated with
increased by the intraparietogastric injection of saline and BTX. Patients
treated with BTX showed long-time significant effects, whereas patients
treated with placebo experienced satiety only in the first 2 weeks after
Satiety, scored on a visual analogical scale, was significantly
Botulinum toxin A and weight loss
D Foschi et al
International Journal of Obesity
The gut plays a major role in the regulation of eating and
energy balance,16mainly as a diffuse endocrine organ able
to act on the central nervous system and the adipose tissue
through a network of hormones, which are able to induce
appetite or satiety while stimulating or inhibiting the motor
activity of the gastrointestinal tract.
Cholecystokinin,17ghrelin18and PYY peptide19levels are
related to the fasting–eating cycle and to the motor function
of the gastrointestinal tract. Duodenal infusion of lipids,
like triglycerides20or fatty acids,21induces early satiety and
causes both gastric relaxation and reduction of gastric
emptying at least by the release of cholecystokinin. These
relationships suggest that satiety mediated by cholecysto-
kinin22and PYY23administration is related to motility
changes of the gastrointestinal tract. Inhibition of the moti-
lity of the stomach could be effective in reducing food
intake. Gui et al.24demonstrated that BTX, a protein known
to inhibit transport of the synaptic vesicles and to reduce
striated muscle contraction, administered into the gastric
wall of rats diminishes food intake and inhibits the increase
of body weight with a statistically significant effect com-
pared to the control (sham-operated) group. Coskun et al.25
found that this effect on body weight was related to a
significant reduction of gastric emptying.
In 2003, Rollnik et al.26reported a single case of a patient
treated with intraparietogastric antral injection of BTXA
(100IU). After 4 months he had a 32.5% reduction in daily
calorie intake and a 9% weight loss. Two further open
studies27,28and a double-blind trial29extended this obser-
vation, but in the series of Garcia-Compean et al.27no
significant effects on body weight and gastric emptying were
observed. As the fundus of the stomach is the main source
of ghrelin30and has a sensory activity31regulating the total
gastric capacity, we modified the technique described
by Rollnik and included the fundus as a target area for
BTX injection. Our results confirm the observation of
Rollnik et al.26and demonstrate, in a double-blind, placebo-
controlled trial, that inhibition of the cholinomimetic
synapses of the stomach in the antrum and fundus cause a
reduction of the threshold of satiety in obese patients.
Motility of the stomach changed with emptying inhibition
and early adaptation to reduced food intake. Satiety
(measured in visual analogue scale) after a standard meal
strongly increased after just a week and persisted during the
follow-up. The strong difference in satiety between BTX-
and placebo-treated patients caused a significant reduction
of body weight, with a mean decrease 41kg/week. Patients
treated with placebo only also showed a significant weight
reduction. The effect on BMI was also significant, as
expected, and was higher for patients treated with BTX. On
the contrary there were no differences between the two
groups in waist and hip circumference.
The changes in the anthropometric measures of obesity of
patients treated with BTX were related to a major change in
their ability to feel satiety. We found that the maximal
capacity of the stomach for liquid foods was reduced at a
higher level when BTX was given. Although there is no
agreement that the maximal gastric capacity of obese
patients is increased,31–34it is likely that BTX acts also by
reducing it. We think that BTX reduces the compliance of
the gastric wall to the caloric load, but we did not study this
aspect. Further investigations are needed to establish the
effect of BTX on the tone of the gastric wall. Furthermore,
the emptying test with monooctanoic acid demonstrated a
significant increase of the emptying half-time in comparison
to placebo. It is unlikely that prolongation of the half-
emptying time as short as 18min could be the cause of the
increased post-prandial satiety and of the reduction in food
intake. It is true that other topical therapies like gastric
pacing32cause a significant delay in the gastric emptying
while inducing a lower threshold for satiety. However, they
probably act also on the capacity of the stomach. Finally,
there is no correlation between a shorter gastric emptying
time and body weight,34,35as many patients (also in our
study) had a rather long emptying time. The mechanism of
the reductive effect of BTX on food intake needs more
It is also important to stress that intraparietogastric
administration of BTX to reduce body weight of obese
patients is very safe. There were no significant side effects
and, although distant effects have been reported for BTX
administration into the striated muscle,36,37our neuro-
physiologic tests exclude that this is the case after intra-
Finally, we would like to consider the main objection to
the use of BTX to reduce the gastric capacity and to increase
after-meal satiety: the short-lasting effect. In this study,
we planned an observation time of 2 months, because in
other therapeutic applications to gastrointestinal diseases,
like achalasia and gastroparesis, BTX has a limited time of
action.13The effect of BTX was fully evident for 8 weeks.
Several patients agreed to extend the follow-up, but all
except one lost no further weight after 3 months. Therefore,
the effect of a one-time administration is limited. For this
significantly increased in BTX patients (Po0.05) 8 weeks after treatment.
Gastric emptying, assessed by octanoic acid breath test,
Botulinum toxin A and weight loss
D Foschi et al
International Journal of Obesity